C10006054 / invoice 10000

Reason: Not Eating Appointment Notes: Overdue remindersHistory: Examination: Reason: Not Eating - 11YOAppointment Notes: Overdue remindersHistory: Examination: QAR, still growly etc, poss abdo discomfort? Rest of palpation and auscultation wnl. Patient Information: - June - Feline - 09/03/2026 Subjective: - Presenting for vomiting and lethargy. - Onset yesterday. Initially rapid breathing with tongue out, but not panting. Quiet demeanour. Vomited wet food last night. This morning, attempted to vomit again but only produced spit, having not eaten since last night. - Past medical history of similar episodes with elevated liver enzymes. Gallbladder removed previously due to gallstones. History of skin lesion and blood test on 19/11/XXXX (year not specified). Blood test in October/November showed ALP 195. Previous episodes have responded to fluids, antibiotics, and time. Currently on medication for arthritis, walking well. Owner to trial reducing dose to half every second day. - Ate wet food for dinner yesterday prior to vomiting. - Caught a mouse recently. Objective: - Blood test results today show elevated liver markers, similar to previous episodes. Pancreas marker also elevated. Blood count is normal. Liver is still functioning (producing glucose, urea, cholesterol). Assessment & Plan: 1. Acute Vomiting & Lethargy with Elevated Liver Enzymes - Assessment or working diagnosis based on the subjective and objective findings: Suspected acute inflammatory liver episode, possibly with concurrent pancreatitis (triaditis). The clinical presentation and blood results are very similar to previous episodes. Unlikely to be toxin-related, although not entirely ruled out. Toxoplasmosis considered very rare. Sickness from mouse ingestion is unlikely as there is no evidence of a bleeding disorder.But does hunt mice! - Recommended diagnostics: An ultrasound may be considered for further investigation of the liver and to rule out remaining gallstones if there is no improvement with medical management. - Treatment plan including medications (with name, dose, route, and duration), diet changes, activity restrictions, and at-home care instructions: Admission for hospitalisation. Commence intravenous fluids with potassium supplementation. Administer antibiotics and pain relief. Will also administer anti-nausea medication. - Follow-up recommendations including time frame for recheck, what signs to monitor, and ongoing care instructions: Reassess this evening to determine progress. If not improving and eating, will likely require transfer for ongoing 24-hour care for 1-2 days. Will discuss with owner later today. Additional Notes: - Owner education provided about the diagnosis, medication use, home care, and prevention strategies: Discussed the seriousness of the elevated liver markers, but noted the positive prognostic indicator of recovery from similar past episodes. Explained the liver is an angry/diseased organ at present but has the capacity to heal with supportive care. Discussed the treatment plan of fluids and medications. - Emergency care instructions including warning signs and when to seek urgent veterinary attention: Discussed the plan for reassessment and potential transfer for ongoing care. - Any specific concerns, questions, or preferences expressed by the owner and addressed during the visit: Owner agrees to leave June for treatment and observation. Discussed the estimated costs, likely exceeding $1,000. Will provide an update call this afternoon.Laboratory: In house level 3 profile :Potassium 3.3, Lipase > 300 TBILI 30.8, ALT > 1100, ALP 151Primary hepatopathy ? Triaditis.. Rec iv fluids as well as ab cover please...Note proteins/glucose and urea still all wnl.. See hx going back to 2023 cholecystectomy at VSS. Cyclical/repeating episodes of gi v and nausea/anorexia and elevated liver markers could also suggest a recurring pancreatitis or cholangiohepatitis. Admit for fluids (add potassium) /ab/prevomax/buprenorphine pain relief  and hospital monitoring. Previously recovered well from similar episodes.Rec iv fluids, abiotics as well as pain relief, cons AUS esp ini2x maintenance KCl spiked (added 20mmol)  fluids till 3pm then reduced to maintenance. Temp 3:30 pm = 38.1, refusing food sachet when coaxed. Rec ongoing overnight care please..Offer AEC POMReason: Nurse: -vaccination -heartworm -worming -flea/ticks Exam: Lab: Assessment: Treatment: Plan:    Vital Signs    Weight: 3.95;       HeartRate: 160;       Temperature: 39.4;       BodyScore: 5/9;